Phone-based Interventions under Nurse Guidance after Stroke II (PINGS II)

中风后在护士指导下进行的电话干预 II (PINGS II)

• 批准号: 10602449
• 负责人: BRUCE OVBIAGELE
• 金额: $ 57.14万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10602449
• 关键词: Academy; Accident and Emergency department; Address; Adherence; Adoption; Adult; Africa South of the Sahara; Age; Algorithms; American; Antihypertensive Agents; Area; Belief; Brain Diseases; Cardiovascular system; Caring; Cellular Phone; Chronic; Country; Data; Disease; Effectiveness; Etiology; Event; Focus Groups; Funding; Ghana; Goals; Health; Health Benefit; Health Personnel; Health Services Accessibility; Health Technology; Health care facility; Health education; Healthcare; Home Blood Pressure Monitoring; Hospitals; Hybrids; Hypertension; Improve Access; Incidence; Income; Intake; Intention; Intervention; Investments; Learning; Measures; Mediator; Medical center; Medicine; Modification; Monitor; Nurses; Outcome; Outcome Measure; Patients; Pharmaceutical Preparations; Physicians; Pilot Projects; Policies; Population; Prevalence; Prevention strategy; Quality of life; Randomized, Controlled Trials; Recurrence; Research; Research Design; Resource-limited setting; Resources; Risk Factors; Self Efficacy; Self Management; Standardization; Stroke; System; Techniques; Technology; Telephone; Testing; Text Messaging; Theoretical model; Therapeutic; United States; United States National Institutes of Health; Work; adverse outcome; blood pressure control; blood pressure intervention; cardiovascular emergency; cardiovascular risk factor; clinical practice; effectiveness evaluation; efficacy testing; evidence base; experience; global health; high risk; hospital readmission; hypertension control; hypertensive; hypertensives; implementation barriers; implementation context; implementation facilitators; implementation strategy; improved; indexing; low and middle-income countries; mHealth; medication compliance; modifiable risk; mortality; post stroke; preference; primary outcome; programs; satisfaction; secondary outcome; stroke incidence; stroke patient; stroke risk; stroke survivor; systematic review; treatment as usual; underserved area; unhealthy lifestyle; usability; usual care arm; vascular risk factor

PROJECT SUMMARY Global estimates suggest that sub-Saharan Africa (SSA) now has the highest incidence and prevalence of stroke. However, limited system resources, meager patient resources, uncoordinated care, and shortage of clinicians, greatly hamper the capacity of countries in SSA to implement effective measures aimed at controlling key vascular risk factors such as hypertension (HTN) to thwart stroke recurrence in routine clinical practice. In particular, SSA has the highest estimated effect size of HTN for stroke causation worldwide. HTN is often unrecognized, undertreated and uncontrolled in a significant proportion of the adult population in this region due to a clustering of factors including cultural beliefs and misconceptions about hypertension, low self-efficacy, non- adherence to treatment, unavailability of health facilities, health personnel, lack of access to of antihypertensive medications, therapeutic inertia by physicians, and other factors. With the anticipated continued transition from primarily infectious conditions to chronic non-communicable diseases, the burden of stroke in SSA is likely to increase even further over the next several decades. Given all of the aforementioned factors, it is an urgent priority for countries in SSA to develop and test self-management interventions to control hypertension among those at highest risk of adverse outcomes. The overall objective of Phone-based Intervention under Nurse Guidance after Stroke II (PINGS-2) is to deploy a hybrid study design to firstly, demonstrate the efficacy in a randomized controlled trial of a theoretical-model-based, mHealth technology-centered, nurse-led, multi-level integrated approach to substantially improve longer term BP control among 500 recent stroke patients encountered at 10 hospitals in Ghana. Secondly, PINGS II seeks to develop an implementation strategy for routine integration and policy adoption of mhealth for post-stroke BP control in a LMIC setting. We will leverage experience gained from the NIH Global Brain Disorders funded R21 pilot study (NS094033) to test efficacy of a refined, culturally-tailored, and potentially implementable intervention aimed at addressing the premier modifiable risk for stroke & other key variables in an under-resourced system burdened by suboptimal care & outcomes. The primary outcome is blood pressure control at month 12 alongside a host of secondary outcome measures such as medication adherence, self-efficacy, cardiovascular emergency department encounters, quality of life, and mediator outcomes. While it is important to establish the efficacy of a nurse-led, m-health-centered self- management intervention for blood pressure control in LMICs, it equally crucial to simultaneously begin crafting an implementation plan. Hence we will seek to identify context-specific implementation facilitators and barriers, to understand the implementation context, and craft evidence-based implementation strategies for routine use & policy adoption of the PINGS intervention in Ghana through multiple stakeholder engagements.

项目摘要 全球估计表明，撒哈拉以南非洲（SSA）目前中风的发病率和患病率最高。 然而，有限的系统资源，微薄的患者资源，不协调的护理，以及临床医生的短缺， 严重阻碍了撒南非洲国家实施有效措施控制主要 血管危险因素，如高血压（HTN），以阻止中风复发的常规临床实践。在 特别是，SSA在全球范围内具有HTN对卒中病因的最高估计效应量。HTN通常 在这一地区的成年人口中，有很大一部分人得不到承认、治疗不足和不受控制， 一系列因素，包括文化信仰和对高血压的误解，低自我效能感， 坚持治疗，没有卫生设施、卫生人员，无法获得抗高血压药物 药物、医生的治疗惰性和其他因素。随着预期的持续过渡， 主要是传染性疾病，慢性非传染性疾病，中风的负担在SSA很可能 在接下来的几十年里会进一步增加。鉴于上述所有因素，这是一个紧迫的问题。 撒哈拉以南非洲国家优先制定和测试自我管理干预措施， 不良后果风险最高的人。护士指导下电话干预的总体目标 卒中后II期（PINGS-2）指南是采用混合研究设计，首先证明 一项基于理论模型、以移动健康技术为中心、护士为主导、多水平的随机对照试验 一种综合方法，可显著改善500例近期卒中患者的长期血压控制 在加纳的10家医院里遇到过。其次，PINGS II寻求制定实施战略， 在LMIC环境中，常规整合和政策采用mhealth用于中风后BP控制。我们将利用 从NIH全球脑疾病基金资助的R21试点研究（NS 094033）中获得的经验， 完善的，文化定制的，潜在的可实施的干预，旨在解决首要的可修改的 中风的风险和其他关键变量，在一个资源不足的系统负担不佳的护理和结果。的 主要结局是第12个月的血压控制，以及一系列次要结局指标，如 药物依从性、自我效能、心血管急诊科就诊、生活质量和 调解结果。虽然重要的是要建立一个护士领导的，移动健康为中心的自我效能， 在低收入国家的血压控制管理干预，同样重要的是，同时开始制定一个 执行计划。因此，我们将努力查明具体情况下的执行促进因素和障碍， 了解实施背景，并制定基于证据的实施策略，以供日常使用， 通过多方利益攸关方参与，在加纳采取PINGS干预措施。